Some people with disembarkment syndrome may sleep far beyond their usual sleep times. Symptoms are sometimes alleviated when the patient returns to the motion that led to their initial symptoms.
However, once this motion stops, symptoms can return, often in a much stronger way than when initial symptoms were developed. Disembarkment syndrome symptoms are often debilitating to the patient. Many patients must limit their work or even quit their jobs. The condition can also have a negative impact on their social activities and lead to a lower quality of life. Causes Disembarkment syndrome cannot be explained by inner ear pathology or structural brain pathology.
We treat all the following disorders. In Table 1 , a diagnostic guideline is provided for patients with motor travel or spontaneous onset MdDS, as refined with elements adapted from publication by Mucci et al. This guideline may serve as a tool in the diagnosis of MdDS. MdDS diagnostic guidelines for patients with motor travel or spontaneous onset, refined with elements adapted from Mucci et al [ 5 ] and Van Ombergen [ 10 ] guidelines.
Symptoms not better explained by other vestibular pathologies or other diagnoses made by a physician or other provider. It is well documented that patients with MdDS are significantly burdened by depression and anxiety, which further decreases their attention to spatial information and working memory [ 11 ], [ , 12 ].
The initial psychiatric screening for depression in this patient was negative, but during the period surrounding her disease course, she reported significant anxiety. Of note, during the disease course, the patient was not able to resume work activities and required minimal to moderate assistance with her functional activities.
Although a definitive treatment for MdDS does not exist, various medical management protocols are currently in use to help relieve the symptoms of MdDS [ 10 ], [ 13 ], [ 14 ], [ 15 ]. Other evidence suggests that success and symptom management strategies between benzodiapines and antidepressants do not differ; both are used as primary treatments [ 14 ].
MdDS and migraines share common pathophysiologic mechanisms, so some practitioners have found success treating MdDS with more cost-effective options such as a vestibular migraine protocol that includes lifestyle changes and prophylactic migraine pharmacotherapy with verapamil, nortriptyline, topiramate, or a combination [ 15 ]. Ghavami et al. A deeper understanding of environment and lifestyle along with concurrent medical management could be greatly beneficial. Modulating neuronal circuits with repetitive transcranial magnetic stimulation TMS over the dorsolateral prefrontal cortex has been reported to decrease the rocking and dizziness of MdDS [ 16 ].
Furthermore, it has been suggested that the vestibulo-ocular reflex VOR may serve to treat the postural instability associated with MdDS [ 17 ]. A study by Dai et al. As noted, these prevoius studies were relatively small in sample size and, in most cases, were not rigorously controlled trials, so further research is needed. This case report highlights the clinical course of MdDS, which remains a poorly recognized, poorly understood, and likely underdiagnosed condition in the medical community.
Workup usually reveals no findings and diagnosis is based on history and examination findings. As the first point of contact, family physicians and emergency physicians play a critical role in early suspicion and diagnosis of MdDS. This is especially important, as a delayed diagnosis is common and contributes to the significant social and economic burden associated with MdDS.
Despite some progress, clinical trials on the efficacy of approaches to MdDS treatment and management are still in early stages, and definitive treatment still remains modest at best. With a focus on the body as a unit, osteopathic physicians could provide benefits to this patient population based on their holistic approach to care. Author contributions: Drs.
Ampomah and Burwell provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; Dr. Ampomah drafted the article Drs. Clark and Arnold reviewed it critically for important intellectual content and helped revise the manuscript; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Informed consent: Informed consent was obtained from the patient included in this study. Persistent mal de debarquement syndrome: a motion-induced subjective disorder of balance. Am J Otolaryngol ;— Search in Google Scholar.
Cha, YH. Mal de debarquement. Semin Neurol ;—7. Mal de debarquement syndrome: new insights. Ann N Y Acad Sci ;—8. The MdDS phenomenon is the natural result of the human brain adapting to environmental motion and is thus the quintessential neurological disorder. There is evidence for brain connectivity to spatial processing areas as being altered in MdDS, some of which can be reversed with treatment.
This island of insight, however, is surrounded by a sea of unanswered questions that we hope to address with continued research. For now, what we know is that if MdDS symptoms do not resolve within several months, the chances of remission get pretty slim. Medications such as benzodiazepines and some types of antidepressants can ease the symptoms, but the development of persistent MdDS often leads to other problems such as difficulties with attention, emotional control, pain modulation, and tolerance to sensory stimuli like light and sound.
Patients with MdDS have spent thousands of dollars on vitamins, diets, hyperbaric oxygen, induced altitude sickness, magnetic bracelets, chelation therapy, and antibiotics. Some have even had inner ear surgery to no avail.
If you can name it, a desperate person with MdDS has likely tried it. But for a rare few, the sensation of persistent motion lingers for weeks. Learn more about vaccine availability.
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